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<br />-_ � .: � � . �� . ' ' DOILDIflG I'Eti!!IT APPLICATIOIJ � ./ �..J��•��� '. � ; i '-
<br />.� Rpplicant T�� Completc Tt�i� :orm • `,� ` �
<br />• � Tf �aore than one buildinq is to be contructed, submit a sc arate .' ���Jr�j 'Y
<br />�. , tlon for each buildin p petmit applica-
<br />, q. fl separatc permit will bc issued for each building.
<br />, � •. .
<br />. �� 'Q+ner G[een;hiP]d^. Tnd'Sinn7.r� Tn�_ IIaiidinq Address 71� s�i,�y��,�,,�..,���n�„r"
<br />�•� Bddress 710 Hinino,;y 4g ;;�rth` verett Lpt 1 Hlock?��ion Park Dlv. '!7 •
<br />, . City �.vArntt Phone �,o_�i7i $�3iyision (Piat) � :
<br />_ � • l�rchitect/Enqincer `'�r�' . . . . .
<br />�� • Ileles s Bounds (Unplatted) .
<br />_ • s � ' City Phone _ �
<br />:,". Conttactor Y•,�nil:tbera Cons�st�ction Sec. Tt.�, gyP '
<br />. ..� , _ _
<br />• %• . �� 1Sddress 790f3 52nr1 Dri.v� td i; � � � ,
<br />7: �tY Ifary�ville Phon� �j°_�76n Commerci,l ' . . ''�
<br />� IIuil3ing Usc �».. •...
<br />-x :
<br />.1� .�; .. . D '7_7_�'831 -75 • , ..�..
<br />. '�� Statc License Nu�ber Acscribe Work to Be Done F?ili -1inr n�]ditio`n'
<br />: �I F5 •iration DatB 1976 � • �
<br />��' � • • SREiCfi PLOT PL.1!: DELOI4' • • -
<br />• j • . � • . • . • ' . . . . . , .. � . = • .
<br />Use of Huilding
<br />�, i • ::. . . . • .. �
<br />,,. • i�New � Ilddition ❑ Repair/:.temo::el
<br />. .� . ' . � • • �Qaluation of Construction S 2(`.�''L-':OC'.
<br />" ;, ' p '. ` .� .. �•. . .. .. �� -' � i • . . PIAT PL7121 REQUI?2ESL:aTS .
<br />� . . . . � . . ' �.` �
<br />•� ' ' ' ' ' ' ' xndicate lot size, name of street , �
<br />' ti: , . . .. + ' �
<br />' ' � ' � . ,� '; . . , • •indicatc location anfl width o� ,
<br />'; ' • � • : : al).cys, 7.ocate proposed ar.d all '
<br />� � ;�,� • . � . � existing buildiaqs, sho•.a distances
<br />. � : . � • �1:. : r �� v . , .y�i , .
<br />,t � ... • to property lines, show diatances
<br />t� � e. . . ' ' , between buildings. , .
<br />. , , . . . , , � . • : Lot size 1d0 x 180' '
<br />' . s . � . . '' . .
<br />•-' • • • : Lot arca 25, 200
<br />� ' . Sq. Ft.
<br />• r.. • . • ' . � Size Of Blcg. ,�;�„ �� Sa. Ft.
<br />�j ' - ' ' Nunber of Stories '
<br />• ' � �. • 2� ' • • ' ' ' IIasement n�i
<br />r.: . �
<br />, ..� `�� ��
<br />� :' . ' . . Signed BY i/ro"' - n�.a�� t ��n
<br />;. . • - .
<br />•- • ' • g Fr� k Grnc �hield^ 259 0111
<br />:
<br />C
<br />" . . �
<br />.. � DO NOT tS:i?TS BELOFI THI:
<br />' _ Datc ?:eceived �Z �'
<br />' Plan Chce;; :7urScr -� a — � -� j '
<br />Valuation z-C;�`':Q_ oe
<br />• • • ' PCSD�t FCC Z(T�. UC�;
<br />Plan Checi: Fcc �
<br />. 1�ota1 Fcc Duc
<br />DSte Issecd '
<br />•.
<br />�• � . . '
<br />or � n n..
<br />Owncr Phone
<br />ISE 07L'L
<br />II_e•2one
<br />Fire 2one �
<br />Occuoancy Grou� _ � _Z
<br />Type of Construction v—�..d
<br />Occupant Load •
<br />Sprinklcrs licquired ' �
<br />. . , • crrv�
<br />APP?2QVEb• FOR gI�ILDING PERMIT
<br />,Date ` 'i � •,'�,_�Y,�
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